Guidelines for Telebehavioral Health Billing Prior Pandemic

Acceptance of Telebehavioral Health During Pandemic

COVID-19 was declared a global pandemic in March 2020, resulting in social distancing mandates and a rapid transition from in-person to remote health care delivery formats. These same mandates also pose significant threats to the mental health and well-being of the public. Similar to prior pandemics, long-term social distancing and self-quarantining behaviors have increased the incidence and severity of anxiety and depression in the general public. As a result, there has been an increased demand for mental and behavioral health providers who use telemedicine (i.e., telebehavioral health), an invaluable solution to reach and serve the behavioral health of the general population at a distance. Telebehavioral health uptake has traditionally been slow but steady, increasing from 15 percent in 2010 to 29 percent in 2017. Nearly 70 percent of psychologists have used telemedicine since May 2020. Approximately 78 percent of psychologists, social workers, and neuropsychologists have integrated telemental health services into their practices since early April 2020.

Telebehavioral Health Billing Prior Pandemic

Despite evidence that suggest high acceptance of telebehavioral services, low insurance reimbursement or non-covered services, hinder providers’ enthusiasm. During pandemic, the Federal Communications Commission’s COVID-19 Telehealth Program has been introduced to provide connected care services to health care professionals and their patients. Likewise, different states have implemented reimbursement laws in response to the pandemic and health insurance companies have broadened coverage for telebehavioral services. Let’s understand these telebehavioral health billing prior pandemic.

Medicare Telebehavioral Health Codes

While private insurance providers have their own policies on how to handle telemedicine, most insurance payers are follow Medicare guidelines. Telehealth codes for Medicare reimbursement for telebehavioral health are as follows:

Aphasia and cognitive assessment: 96105, 96125
Behavioral screening: 96127
Diagnostic evaluation: 90791, 90792
Psychotherapy: 90832, 90833, 90834, 90836, 90837, 90838
Psychoanalysis: 90845
Group psychotherapy: 90853
Family psychotherapy: 90846, 90847
Psychological and neurobehavioral testing or status exam: 96116, 96121, 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139
Crisis intervention and interactive complexity: 90839, 90840, 90785
Speech-language behavioral analysis: 92524
Psychological evaluation: 96130, 96131
Neuropsychological evaluation: 96132, 96133
Psychological & neuropsychological test administration & scoring: 96136, 96137, 96138, 96139
Health behavior assessment: 96156, 96160, 96161
Health behavior intervention, individual: 96158, 96159
Health behavior intervention, group: 96164, 96165
Health behavior intervention, family with patient: 96167, 96168
Developmental screening and testing: 96112, 96113
Adaptive behavior assessment: 97151, 97152, 0362T
Adaptive behavior treatment: 97153, 97154, 97155, 97156, 97157, 97158, 0373T
Therapeutic interventions: 97129, 97130
Therapeutic interventions (group): 97150
Smoking and tobacco use counselling: 99406, 99407

Place of Service (POS)

Place of Service (POS) is the box 24b on a standard CMS-1500 form.

POS 02: Telemedicine provided other than in a patient’s home. The location where health services and health-related services are provided or received through telecommunication technology. Patients are not located in their home when receiving health services or health-related services through telecommunication technology (effective January 1, 2017) (description change effective January 1, 2022, and applicable for Medicare April 1, 2022). This is the preferred POS to use for private insurance to ensure reimbursement.
POS 11: Office visit. This location is reported if the location is somewhere other than a hospital; skilled nursing facility (SNF); military treatment facility, community health center; state or local public health clinic; or intermediate care facility (ICF) where the health professional consistently delivers health examinations, diagnoses, and the treatment of diseases or injuries on an ambulatory basis. This POS was used early on during the PHE while insurance payers were updating their systems to accept POS 02 and related modifiers. Some insurance payers are still requiring the use of POS 11 instead of POS 02 if the proper modifier shows that the session was a virtual visit. It is important to check with your provider representative if you have questions on what POS to use.
POS 10: Telemedicine provided in patient’s home. The location where health services and health-related services are provided or received through telecommunication technology. The patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health-related services through telecommunication technology (this code is effective January 1, 2022, and available to Medicare April 1, 2022). POS 10 is new, so insurance payers have not updated their policies to include this POS. Experience shows us that insurance payers will warn you ahead of time via newsletters about when they will begin implementing new POS for telemedicine claims provided to a patient while the patient is located at their residence. Until then, it is best to continue to monitor this possible upcoming change and prepare for it.

Telemedicine Modifiers

For Audio & Visual: The modifier will need to land in Box 24d on a standard CMS-1500 form

GT is the preferred modifier by most insurance payers.
95 is still used in some states as the preferred modifier. Check with the Provider Relations department to see what that insurance payer requires.

Telemedicine Modifier Audio Only

FQ modifier is being released for audio-only services as of 1/1/2022; however, because this modifier is so new, your insurance payer is likely not able to process a claim with this modifier. It will take time before this modifier is regularly reimbursed. This is yet another thing that needs to be brought up with a provider representative.

Legion Health Care Solutions is a leading medical billing company providing complete billing and coding services to ensure accurate insurance reimbursement for your practice. To know more about our billing and coding services for telebehavioral health, contact us at 727-475-1834 or email us at info@legionhealthcaresolutions.com

Reference: Telehealth for behavioral health care

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